1770080327 NPI number — CHARLESTON CARDIAC SURGERY ASS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770080327 NPI number — CHARLESTON CARDIAC SURGERY ASS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLESTON CARDIAC SURGERY ASS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770080327
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2655 COLLINS AVE APT 1611
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33140-4718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3270 NW 36TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33142-5036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-621-6182
Provider Business Practice Location Address Fax Number:
305-634-4522
Provider Enumeration Date:
04/10/2018

Additional Information

Authorized Official

Authorized Official Last Name:
WAHI
Authorized Official First Name:
RAKESH
Authorized Official Middle Name:
Authorized Official Title or Position:
SURGEON
Authorized Official Telephone Number:
815-621-6182

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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